Finding Easy, Everyday Handling Techniques for our Patients Dr. Miranda Logan Dog Body Language: How to make it through o the day - Get Low Stress Handling Practical behaviour Certified www.lowstresshandling.com modification pharmacological - Excellent book: Low support Stress for Handling, Restraint and Behavior Modification of Dog and anxious/aggressive Cats by Sophia Yin pets - Book Dr. Miranda for puppies G. Logan to CenCan get them 2017 started right: Perfect Puppy in 7 Days: How to Start Your Puppy Off Right by MVMA Sophia 2017 Yin Dr. Miranda Logan - Remember, this is all about the pet s perspective of the situation - Good footing, blue yoga mats - Gentle leaders be able to fit quickly and quietly - Plastic basket muzzles safest for your staff, easy to treat through them - Bumpers are easy to use - Mediations o Alprazolam do a test dose when O will be home for 6 to 8 hrs Give 2 hours before appt then 20 to 30min before appt The Bible 25kg = 1mg 12.5kg = 0.5mg 6.25kg = 0.25mg o Trazodone I start 2 to 3 days in advance 2 4mg/kg BID o Gabapentin 2 4mg kg 2 to 3 hours before o Sileo stay tuned Genetics of behaviour The number 1 killer of dogs and cats is behaviour Behaviour is a polygenic trait with strong environmental influences How puppies are raised and trained has a huge influence on their behaviour.how much of behaviour is hereditary? 1
Genetics of behaviour Not all behaviour problems need a behaviour consultation Silver fox experiment in Russia Barking Over 45 generations, captive foxes were selected Jumping for breeding up based solely on the basis of their Digging tolerance in of the humans. yard Not Two coming strains were when developed called. One strain was made up of animals selected because they were more comfortable with humans. The other strain was not selected for breeding based on any behavioural traits. Kinds of Aggression Foxes became able to read humans like dogs do As the foxes became more tame, their morphology also Interdog changed Play Impulse Control Food Large, sometimes floppy ears Fear Protective Patchy colouring Territory Pain Related Curly tails Predatory Redirected Barking Maternal Learned Tail wagging Component of all behaviour Context Morphology of Aggression and behaviour Normal defending owners from theft, Did humans originally select dogs based on their attack etc looks or did the morphology change as dogs Abnormal became more social? attacking people when they hug Genes for behaviour (neurotransmitters) are linked to (or are themselves) genes for conformation 2
Causes Nature (Genetics) and Nurture (Environment) Medical Seizure activity Neoplasia Disc disease Pain Endocrine disease Liver disease Hydrocephalus Arthritis Not your average foxes 3
Nature and Nurture Underlying motivation of Fears, aggression Phobias and is anxiety OCDs Flank sucking Tail chasing Fly biting (medical?) Noise phobias Thunderstorm phobias Generalized anxiety Separation anxiety Anxiety / Aggression CANNOT be 5 Main Factors cured Affecting Success of Treatment Only Draft Client compliance Age of onset Predictability Early intervention gives better chance of Duration of behaviour Pattern of Behavioural CONTROL changes in response to environmental, It is like treating behavioural Diabetes and pharmacological intervention 4
Humans Treatment can Elicit inappropriate behaviour by: Medical workup (bloodwork included) Proper diagnosis Staring Appropriate Handling feet/head expectations Reaching over head Behaviour modification Pushing on hind end Environment Stepping over modification Disturbing from sleep +/- Pharmacological support Physical corrections Alpha rollovers Leash corrections Verbal corrections Pushing/pulling off furniture Treatment Plan Get proper help You are liable for your recommendations ANYONE can call themselves a trainer or behaviourist What are the qualifications of the individual? Training Background Verbal and non-verbal communication Continuing Education There is a rule structure Methodology We need to know what is normal and abnormal Happy Basics General Treatment Ears forward Keep it simple Relaxed Appropriate muscles rewards Loose No movement punishment whatsoever of the Teach/Reward tail relaxation sit is the stop and reevaluate behaviour Normal sized pupils Reward spontaneous fantastic behaviour (thanks for paying attention everyone!) 5
Know your normals! General Treatment Cont d Humane set of rules Protocol for deference Deep breath exercise Reward all appropriate behaviours whether asked for or not Humane tools face halters, harnesses Excellent Puppy Play General Treatment cont d Medication Treat/reward based on the what dog wants to work for Monitor progress Remember this is all about the emotional context of the situation for the dog! True behaviour modification is a humane rule structure that allows dogs to replace one set of rules that encourages reaction, with another that allows the animal to relax and to take his or her cues from the contextual environment. True behaviour modification involves clear signaling and learned trust from both participants, and reliability from humans. Dr. Karen Overall Bhr consult for interdog aggression 6
Body Language Signals The aggression we see is often driven by anxiety. The Lip licking main goal of behaviour Ear modification position therapy is to change the emotional state of the pet. Yawning Freeze Head turning Hackles Circling Play bow Tail carriage Whale eye Grin Eyes Back sleeping Muscles tense/relaxed Early Treatment Benefits Decreased meds and/or dose Shorter treatment period Less practice Learn more easily Human animal bond less strained Cannot cure BUT less severe form Many, many more You know your sympathetic nervous system is on when.. 7
More eyes We need to stress to our owners that early intervention gives better chance of control. Behaviour Modification We do it everyday Problem: puppy jumping up Typical responses No, Down, Push off Alternative ignore behaviour and reward sit Draft Protocol for Lip Deference Lick Have the dog sit before any interaction Sit is the stop/re-evaluate, look to owners for appropriateness of their behaviour. Goal is to sit calmly Ears Only 8
Deep Breath Paw Exercise up We can actually teach dogs to take a deep breath Very simple Calming Can be done very quickly Deep Breath Exercise 3 yr old Fear Aggression Yawn 9
Watch Nares Tail position Teeth Gentle Leader Aid in behaviour modification Easily, safely and gently stop inappropriate behaviour Can be on hours at a time 10
Plastic Basket Muzzle Pharmacological Play bow support BZD - alprazolam, lorazepam, clonazepam TCA amitriptyline, clomipramine SSRI fluoxetine, paroxetine, sertraline SARI (dual serotonin 2A agonist/serotonin reuptake inhibitors) - trazodone Gabapentin Draft Less commonly Muscles used: Only Centrally acting alpha agonists clonidine, medetomidine, dexmedetomidine MAO inhibitors selegiline Azaspirones buspirone 11
Never use Furrowed Acepromazine Brow NEVER NEVER NEVER Especially with noise phobic dogs Will make WORSE long term! Weaning off Panting medications Rebound syndrome Original problems reappear Withdrawal syndrome New and distress signs downdraft Normal Curled Neurotransmission Only 12
SSRI Effects on Neurotransmission Be careful about patting a curled up dog. They are protecting themselves. Clomipramine Freeze Separation anxiety Generalized anxiety Eliminatrion & aggression disorders Pruritis Self mutilation, acral lick dermatitis, compulsive grooming Narcolepsy OCD toodraft Feel have Clomipramine Contraindicated in animals with urinary retention, glaucoma and uncontrolled cardiac arrhythmias Sick euthyroid syndrome Can affect liver enzymes, alter liver enzymes Only 13
Clomipramine Dosing 1mg/kg BID 7 days 2mg/kg BID 7 days 3mg/kg BID 7 days 4mg/kg BID thereafter. Fluoxetine Handling Techniques Aggression/impulse control aggression Separation anxiety Be careful with direct eye contact. Panic disorders Approach OCD from the side with your side. Crouch down with hand out and low. Use More quiet economical voice. than clomipramine Be calm even during aggressive incident. 0.25mg/kg SID 7 days, 0.5mg/kg SID 7 days, NEVER 0.75mg/kg punish!!!! SID 7 days then 1mg/kg SID Do not Can corner safely increase to 2mg/kg SID Honest Body Language Fluvoxamine Use when have anorexia on fluoxetine Recommended dosing - 1mg/kg SID BID I usually start at 0.25m/kg SID 14
Sertraline Jimmy 14 weeks old Panic Generalized anxiety 1mg/kg SID BZD Anxiolytic May increase hunger Disinhibition of aggressive behaviours uncommon Dogs cannot become dependent* Alprazolam Panicolytic Use to prevent anxiety Use to prevent making distressing memories Give full dose if has had very bad experience at your hospital 15
Alprazolam Best to do a test dose when owner will be home for 6 to 8 hours Give a dose 1 ½ to 2 hours before event Can repeat half to full dose half hour before event then q 6-8 hours Dosing 0.02 0.04mg/kg OR: 25kg = 1mg 12.5kg =0.5 mg 6.25kg = 0.25 mg If have adverse effect to one BZD, it does not mean they will have adverse reactions to other BZD Clonazepam 0.125-1mg/kg q 8 12 hours Lorazepam 0.02 0.1mg/kg q 8 12 hours Trazodone (SARI) Panic and phobias Can be given starting 3 days prior to vet visit. Will have no effect on your premed if given morning of surgery. Wide range: 1.7mg/kg-9.5mg/kg SID TID Can be used on an as needed basis like a BZD 16
Gabapentin Lucy Emergency behaviour appointment because 7 month old puppy attacking owner Anxiety disorders including panic Generalized anxiety disorder Social phobias Wide dosing range I usually have positive effects at 2 4 mg/kg SID - TID Can go up to 20mg/kg BID Will dog be ok with kids? Amitriptyline Mild separation anxiety Generalized anxiety (mild) Inappropriate urination 1-2mg/kg BID What about this dog? Clonidine Noise reactivity Panic/panic disorders Hyperarousal/hyper-reactivity (think PTSD) Be cautious using with TCAs 0.01 0.05mg/kg as needed BID Max dose 0.9mg for medium sized dog 17
Cane Corso 3 months Serotonin Syndrome (Toxicity) 1 st week of treatment or when changing/adding medications. Be aware of tramadol Train owners to get baseline HR In a pinch - RR Cyproheptadine 1.1mg/kg PO and supportive treatment Cardinal as indicator Rules of Thumb TCAs and SSRIs take 6 8 weeks to take full effect. You will see something in 2 to 4 weeks Do NOT stop prior to anesthesia adjust your premed instead. Alternative Therapies Thundershirt Kodak Walking the WalkDraft Calmz acupressure vest Muttmuffs Doogles Calming Cap Only 18
Supplements May help in very mild situations Journal Myths 19
Intellectual Stimulation Food puzzles Scent walks Herbs in back yard or house Hiding toys Flavoured ice cubes Operant Conditioning We can tell the animal exactly what it is doing right. We can change the emotional feeling of the situation very easily. Food Aggression Humans make it an issue Preventative won t work on special needs puppies/dogs Avoidance is best Separate room 20
Interdog Aggression Often occurs between 1-3 years of age Not associate with sexual maturity (6-8 months of age) Anecdotal: worst fights are between females. Interdog Aggression - Unfamiliar React because they are afraid of other dog or apparently think there is a social threat. Easier to control because owner can control situations where dog is in contact with other dogs. Interdog Agg - Housemates Not due to: Inadequate socialization abuse Two scenarios Often younger dog challenges older dog at social maturity Older dog perceives threat that isn t there Context of aggression very important 21
Interdog Agg - Housemates Key to treatment: ALWAYS reward the dog being the most appropriate for the situation. Interdog Agg - Housemates Potentially one of most dangerous forms of aggression Dog attacks another dog who is giving appropriate body language serious threat for injury/death 22
Separation Anxiety Hyper-attachment to owners Genetic component Anxiety related behaviours occur when owners are in process of leaving or have left the home. Treatment Trade show Video, video, video Pharmacological support Separation Anxiety Fail 23
Treat Early You cannot reward fear! Old Owners are to ignore the dog with separation anxiety until relaxed New Speak low and calm. When stops jumping, pacing, panting Sit, Deep breath If cannot calm/gets worse Hold or press on pet Start exercises involve cognitive choices ie go upstairs, down a step, up two steps Exercise Can affect serotonin levels Does not affect dog s focus on owner leaving Jasper 2016 24
5 month off Signalment 10 year old MN Australian Shepherd X Lab 65lbs (BCS 3) Anxiety is exhausting Presenting Complaints 1. Destroying house during thunderstorms (Serious) History Adopted at 10 weeks of age (Kijiji) Very food driven since puppy Formal obedience training as puppy (clicker based) Would urinate on stairs while housetraining Scared of thunderstorms since puppy shake and hide Seems to cause more destruction on days when exercised 25
History Tug of war Has broken 3 of the canine teeth trying to get out of crate. Currently being monitored by rdvm Owner has had a number of roommates throughout life. Second long term relationship ended a few month ago. Owner currently working nights Getting worse recently - a grey sky can now trigger him to be destructive Destroyed closed bedroom door Knocked over plant stand Opened cupboards and destroyed garbage and recycling bins Urinated on carpet Takes upwards of 4 hours to calm down after a storm Trial of trazodone Very sedated Diarrhea rdvm had started at very high dose Your Body Language Observations Appt August 29, 2016 If you are seeing calming RR 36 signals, evaluate Explored what room you are doing! Very appropriate body language Initiated contact with me Very food motivated and was easy to show owner how to start the deep breath exercise Working Diagnosis Thunderstorm phobia 26
Treatment Plan Bloodwork (CBC, chemistry screen, T4+/- TSH, ft4) performed in house ALKP 342 (23-212 U/L) Start Hepatosupport supplement Pharmacological support Fluoxetine + alprazolam on an as needed basis Fluoxetine 10mg SID 7 days, 20mg SID 7 days then 30mg SID thereafter Alprazolam 1mg 1 ½ hours before leaving when anticipate thunderstorm Tom Treatment Plan cont d Get video of when he is left home alone Protocol for deference Deep breath exercise Colour journal Do you want to pat this dog? Follow up Sept 28, 2016 Currently on Fluoxetine 20mg SID Owner has started to video behaviour when alone Not seeing any positive changes in behaviour when alone Trial of alprazolam no sedation 27
Contact info Follow up Oct 10, 2015 mglogan11@gmail.com Currently on 30mg www.foothillsanimalhospital.ca SID Facebook: Foothills Animal Hospital Every night in past week has destroyed something and is urinating around house (work and hockey hint) Working Diagnosis Thunderstorm phobia Separation anxiety Questions? Follow Up Oct 25, 2015 Fluoxetine and alprazolam not having much effect Urinates within first hour of owner leaving Pants and jumps up on kitchen counter Discontinue alprazolam Trial Clonidine 0.3mg BID as required 28
Follow Up Nov 5, 2016 No effect with clonidine trial So I have administered the new medication as per the directions you provided and there is no change, in fact it seems like he is getting worse. Last night he chewed up the closet door He is also pissing every night on the landing of the stairs. He is still pacing for at least 3 hours after I leave Cont d Discontinue Clonidine Trial diazepam 20mg 1 hour before leaving Nov 7 No urination or destruction Increased appetite Finally has been on fluoxetine 8 weeks increase to 40mg SID Pacing and panting only for whole time owner gone Orthopedic involvement? Add on Gabapentin 100mg BID 29
Follow Up Nov 15 FINALLY some positive news Only paced for 15 min after owner left and jumped on counter twice. No urination or destruction Follow up Nov 22, 2016 Jasper has had his best day since like March. I just finished watching the video from when I was at work last night and it actually put a smile on my face instead of feeling sorry and sad for Jasper. He might have panted/paced for 30min total. He didn t jump on the counter once, he didn t piss. He didn t knock over the recycling can, he didn t move the rug by the front door, he didn t try to chew anything. He did nothing but sleep upstairs and on the couch Only Keys to Separation Anxiety Medication is vital Video monitoring vital Draft 30
Impulse Control Aggression Formerly called dominance aggression Anxiety disorder look at body language Act aggressive as way to ask questions They do the behaviours, not because they want to, but because they feel they have to. Impulse Control Aggression Misinterpret normal signals as challenges Push/pull off furniture Reach over top Being stared at 31
Fear Aggression Very common These dogs are usually very obvious in their body language More likely to bite from behind If feel cornered, increased chance of a bite occurring NEVER punish!!!! 32
33
Compulsive Disorders and Stereotypies Stereotypies can be interrupted Compulsive animal very difficult to interrupt Examples acral lick dermatitis, tail chasing, spinning, pacing 34
Cullen 2007 Signalment Cullen 8m old MN SCWT 17.4kg BCS 3.75 Presenting Complaints 1. Aggressive when afraid. (Serious) Doggie daycare Visiting relatives Obedience classes Vet visits 35
History Got at 8 weeks of age from CKC registered breeder Timid as puppy (father also timid) Kicked out of obedience classes Withdraws/hides from new people and situations Plays appropriately with two cats in household Barks continuously at visiting friends and relatives More fearful at 5 months Snapped at 6 months of age Barks at people when on walks Cullen s video Only Observations Hypervigilant Lip licking Yawning Never attempted to explore the environment Growling whenever I moved or he heard something in treatment area. Barked and lunged during first hour No exploration of environment Kept trying to hide chairsdraft under the 36
Working Diagnosis Fear aggression I would now add generalized anxiety Treatment Plan Bloodwork (CBC, chemistry screen, T4+/- TSH, ft4) Pharmacological support fluoxetine (Prozac) Treatment Plan cont d Security Avoid all triggers of anxiety children, strange people, going to work No punishment for growling (this includes verbal no ) Keep on leash Supervise at all times Gentle Leader and 6 leash Plastic basket muzzle 37
Treatment Plan cont d Protocol for deference Dog body language - yawn Massage therapy Increased aerobic exercise Operant conditioning Protocol for relaxation Follow Up Met with monthly from Feb 2007 to March 2008 then on an as needed basis. Issues that came up Upset when O cut rice crispy squares Didn t recognize daughter in hat & coat Barking at people/dogs walking by house Almost bit brother when visiting Growling at other dogs on walks August 18/08 Break through 38
Feb 2009 Cullen Nov 2016 39
Questions? Mystaya 2010 40
Signalment Mystaya FS GSD 14 months old Behaviour complaint Fearful and reactive to other dogs starting after having been attacked by larger dog at 2 ½ months of age. Work up Physical exam - NAF Bloodwork and urinalysis NAF History of urinary tract disease Pannus under control Consultation 41
Working Diagnosis Interdog aggression Treatment plan Protocol for deference Protocol for relaxation Gentle Leader Reviewed calming signals Operant conditioning head turns away from dogs Follow Up July 27/10 Improvement seen with other dogs Anxiety in general increasing Scared drift wood, objects out of place on walks Barked and lunged when people stopped on walks to look at her Discussed clomipramine Follow Up Aug 6/10 started Clomicalm (clomipramine) 72lbs 40mg BID 7days 80mg BID 7 days Switched to generic 100mg BID thereafter Side effects: licking lips, swallowing, zombie like last 4 days 42
Spring/Summer 2011 Diabetes insipidus Episioplasty for chronic UTI July 19/11 episode when entered house after exercise, hind limbs gave out, went lateral, froze and became cyanotic for 10 sec Diffs: dilated cardiomyopathy, 1 epilepsy, myopathy Behaviour Relapse Nov 2/11 Starting to bark and lunge at dogs during agility Becoming more difficult to handle on walks when meet people with and without dogs. Only Medication Change Attempted slow wean down of clomipramine to start fluoxetine This was a failure! Dec - Emergency email to Dr. Overall Stop clomipramine for 24 hours then start fluoxetine 10mg SID 7 days 20mg SID 7 days 30mg SID thereafter Draft 43
New medical problems Late Dec-January Vomiting & Hematuria Bloodwork and u/a (rbc tntc) Radiographs NAF Barium series - NAF GI diet no effect Medication trial (Amox, Metronidazole then Fenbendazole) Referral to internal medicine specialist Recommendation - Take off all meds Feb Emerg Email Decrease fluoxetine to 20mg SID Add Gabapentin 200mg BID Decrease in vomiting Trial of Metacam for possible interstitial cystitis No effect Emerg Email March 6 Biting at owner during agility because so worked up Whining, panting, jumping away from objects on walks Increased gabapentin to 300mg BID Added amitriptyline 50mg BID Alprazolam trial 1mg before walksdraft Only 44
Seizure Activity April 5/12 5 min seizure, (vomiting 1-3 times daily, hematuria) PE NAF Bloodwork acanthocytes Ultrasound NAF Emerg email KBr 20mg/kg SID May 5 Bloodwork KBr 5.5 (12-31) Alt 78 (5-60) Owner s description She usually gets up from a deep sleep and starts whining and drooling and paces, she looks like she is going to vomit so I can't really tell which one is coming. She then collapses on the floor and starts paddling like she is swimming but her limbs are very stiff. Her eyes are open but there is nothing inside of them. I always think she is going to swallow her tongue but you said she can't. She usually pees during the seizure. When she is done she is very anxious and stumbles around like she can't see. Sometimes this lasts a long time and sometimes it is very short. I try to get her to cuddle with me and stay calm and I turn out the lights and any noise. 45
Seizure Activity DATE LENGTH OF SEIZURE APPROX TIME OCCURRED THURS APRIL 5/12? 1:00 AM FRI APRIL 6/12 4M 11:30 PM TUES APRIL 10/12 3M 40S 11:15 PM SUN APRIL 15/12 6M 11:55 PM THURS APRIL 19/12 3M 42S 11:45 PM FRI APRIL 20/12 2M 9:10 PM THURS APRIL 26/12 5M 8:15 PM SAT APRIL 28/12 8M 9:30 PM SUN APRIL 29/12? 4:55 PM THURS MAY 3/12 8M 11:50 PM SAT MAY 5/12 9M 45S 9:05 PM SUN MAY 6/12 3M 2:30 AM MON MAY 7/12 7M 37S 8:30 PM SAT MAY 12/12 10M 20S 12:30 AM WED MAY 16/12 3M 10S 1:05 AM SUN MAY 20/12 8M 25S 12:25 AM Unresolved Neuro referral not done owner afraid only options are MRI or CT scan Phenobarbitol? Stop KBr? Client Fired!!! 46